Abstract
Adjunctive uterotonic in patients at risk of primary post-partum haemorrhage may reduce its incidence. To compare the effectiveness and safety of adjunctive rectal misoprostol with adjunctive intravenous oxytocin for the prevention of primary post-partum haemorrhage in at risk patients. A total of 122 patients with risk factors for uterine atony were allocated to receive either 600µg of rectal misoprostol (n= 61) or 20IU of oxytocin infusion (n=61) after routine management of third stage of labour. Post-partum blood loss was measured using differential delivery towel and pad weighing. There was similarity in the estimated post-partum blood loss, with no significant difference in the mean post-partum hematocrit levels between the adjunctive rectal misoprostol group and oxytocin infusion group (P=0.712). There was no difference in the need for additional intervention of uterotonics between the two groups. There were however, higher incidences of shivering and pyrexia among those that received misoprostol compared with the oxytocin group. Rectal misoprostol is as effective and safe as oxytocin when used as an adjunctive uterotonic in preventing primary post-partum haemorrhage in patients with risk factors for uterine atony after active management of third stage of labour.
Highlights
Post-partum haemorrhage (PPH) is an important cause of maternal morbidity and mortality especially in the developing countries.[1]
Studies on adjunctive treatment for at risk patients after active management of third stage of labour (AMTSL) for prevention of PPH is crucial towards further reduction of PPH especially in low to middle income countries (LMICs)
The incidence of PPH in the misoprostol group was 19.6% which was similar to 18.5% observed in the oxytocin group and comparable with 22.2% Versus 20.9% respectively reported by Badejoko et al in South West Nigeria.[17]
Summary
Post-partum haemorrhage (PPH) is an important cause of maternal morbidity and mortality especially in the developing countries.[1]. These challenges herald the need for alternatives. Objective: To compare the effectiveness and safety of adjunctive rectal misoprostol with adjunctive intravenous oxytocin for the prevention of primary post-partum haemorrhage in at risk patients. Conclusion: Rectal misoprostol is as effective and safe as oxytocin when used as an adjunctive uterotonic in preventing primary post-partum haemorrhage in patients with risk factors for uterine atony after active management of third stage of labour. A prospective study to compare the effectiveness of adjunctive rectal misoprostol or oxytocin titration in the prevention of primary post-partum haemorrhage in at risk patients.
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